By Steve Ariens P.D. R.Ph.
Having been a “student” of our bureaucracy/bureaucrats/politicians for some 3+ decades it is easy to see that there are seldom any major moves, only numerous “tweaks” to existing laws/rules/regulations. After Congress created the “black drug market” with the passage of The Harrison Narcotic Act in 1914, The USA has consistently had about 1% +/- of the population that are serious illegal substance abusers for the last century.
Starting in the year 2000, the Joint Commission decided that “pain management” was the fifth vital sign and that hospitals were expected to address pt’s pain levels throughout the pt’s stay in the hospital.
It shouldn’t surprise anyone that this focus on a patient’s pain became not only a “fifth vital sign” in the hospital setting, but also pain started getting increased attention in the ambulatory setting.
As a result, many patients who were dealing with undiagnosed mental health issues – like additive personality disorders – were exposed to opiates. The outcome was pretty predictable, a few percent of them received opiates for their pain, ended up going down the path to addiction.
This is not to say that these people would not have started down this path of abusing some legal/illegal substance without this first legal interactions with a opiate.
More and more bureaucrats/politicians seem to have come to the conclusion that all people who are abusing/addicted to legal/illegal opiates because they had been given a prescription for some opiate to treat some acute pain. They have also come to the (false) conclusion that if they limit the days supply of opiates prescribed for acute pain, these people would never start using heroin or some other illegal opiate and opiate OD’s would cease to happen.
Chronic pain is generally described as someone needing opiates for more than 90 days. If our bureaucracy is creating three, five or seven days supply limits on legal prescription(s) for acute pain, are they hoping that no one will qualify for long term use of opiates for chronic pain, since no newly diagnosed pain patient can be prescribed opiates for their pain and reach the 90 day threshold to be considered a chronic pain patient?
Anyone with three brain cells holding hands can realize that we are going to get newly diagnosed patients that will be in need of long term opiates for the pain associated with their chronic disease and/or pain resulting from a serious accident.
So what is the potential problems with this “no man’s land” between a prescriber being able to treat acute pain and treating newly diagnosed pt that will be suffering from pain that will end up being treated for chronic pain?
Will this “no man’s land” be used by our judicial system to ID prescribers who are treating chronic pain pts that fall into this “opiate limbo” as “pill mills” and used it as justification to raid the prescriber’s office, seize their assets and shut them down? Or will it just be used it as further method of intimidation of prescribers to deny pain pts with their medically necessary therapy ?
We have all seen that there seems to be little that our judicial system will not do, to keep the funding of the war on drugs justified to Congress.
Steve Ariens is a retired pharmacist who is a frequent contributor to the National Pain Report.